ISSUES

NUMBER 1

RS. CLINTON. Thank you, and please be seated, and welcome to the White House. I am pleased to see all of you here today for the presentation of this report of the Presidential Advisory Committee on Gulf War Veterans Illnesses.

The work of this committee reflects the administration's commitment to finding answers for the thousands of brave men and women suffering from undiagnosed illnesses after serving in the Persian Gulf War. And it reflects the president's abiding commitment to being responsive to and responsible for our veterans and their families.

I know that there are numbers who are here of the commission, and I'd like them, if they would, to stand so that we could see all they're all standing. We appreciate very much the time and effort that went into this service. And I know firsthand how important and difficult your task has been.

I heard stories of hard-working men and women who could no longer keep steady jobs and support their families because of their illnesses. One veteran officer who had been diagnosed as 100 percent disabled told me about the healthy and active life he had led before his tour in the Persian Gulf and about his frustration in seeking effective treatments for his systems.

In February 1995, I reported to the president and the chief of staff on these findings and recommended some steps the administration could take in the future, including the creation of a blue ribbon panel to investigate these issues further. And I had the privilege of testifying at the first meeting of this committee in August 1995, and I've been following the work that has been done closely ever since.

Over the last four years, the president and I have received many heartwrenching letters from Gulf War veterans and family members. Many veterans and their family members said they felt that their country had forgotten them. So in the fall of 1994, the president asked me to explore the issues surrounding the health needs of Gulf War veterans and to look into the federal government's efforts to address their concerns.

Shere today, and I'm also gratified

o I'm particularly gratified to be

that our government is making progress and being responsive in taking affirmative steps to do all that can be done on behalf of our veterans and on behalf of future members of our forces who might be put in harm's way in the future.

I want to thank all who served for their persistent efforts on this committee and for considering thoroughly the diverse and strongly held opinions, theories, explanations and evidence about these illnesses. But I particularly want to thank Gulf War veterans and their families for taking the time to share their experiences with this committee. We could not have had a better chairperson of this presidential committee than the one who was persuaded to undertake this significant responsibility, and it's my pleasure now to introduce Dr. Joyce Lashof, who will tell us more about the committee's findings.

Lashof. Thank you very much, Mrs. Clinton, especially for your compassion and your interest in this important issue. And thank you, Mr. President, for your very courageous leadership for wanting to get to the bottom of this issue and the effort you've made to bring this committee about.

Mr. President, Secretary [of Health and Human Services Donna E.] Shalala, Secretary [of Veterans Affairs Jesse] Brown, Deputy Secretary [of Defense John P.] White and

government's approach to addressing the health concerns of veterans who served in the gulf. In all areas save one, these suggestions are to fine-tune the government's programs on gulf health matters. Overall, the government has responded with a comprehensive series of measures to resolve questions about Gulf War veterans' illnesses.

Unfortunately, the positive nature of these efforts has been diminished by how the Department of Defense approached the possibility that U.S troops had been exposed to chemical weapons. It is essential now to move swiftly to resolving Gulf War veterans' principal remaining concern - how many U.S troops were exposed to chemical warfare agents and to what degree.

The committee is pained by the atmosphere of government mistrust that now surrounds every aspect of Gulf War veterans' illnesses because of these concerns. It is regrettable, but also understandable.

Our investigation of DoD's efforts related to chemical and biological weap

existing scientific data, none of the individual environmental Gulf War risk factors commonly suspected appears to be the cause. And while the government finds that stress is while the committee finds that stress is likely to be an important contributing factor to Gulf War veterans' illnesses, the story is by no means complete.

Veterans, their physicians and policy makers clearly stand to benefit greatly from the comprehensive range of ongoing research. We believe a continued commitment to longterm studies is important. Some health effects such as cancer would not be expected to appear until a decade or more after the end of the Gulf War.

Additionally, the committee recommends new research in three areas: the long-term health effects of low-level exposure to chemical warfare agents; the synergistic effect of pyridostigmine bromide with other Gulf War risk factors; and the most physical response to stress.

However, veterans and their families will realize maximum benefits from such research only through a thoughtful, inclusive dialogue between veterans and the departments. In light of current public skepticism, the committee

communication effort is the only way to repair public trust.

The volunteers who served in defense of our national interest deserve complete and accurate information about the risks they faced, and I am sure that we will be able to provide it to them.

The committee also felt there were lessons to be learned about health matters based on Gulf War experience. We believe the government can avoid many future postconflict health concerns through better communication, better data and better

early efforts were superficial and lacked credibility. DoD's failure to seriously investigate these issues also adversely affected decisions related to funding. research on health effects of low-level exposure to chemical warfare agents. DoD was intransigent originally in refusing to fund such research until late this year. This has done a disservice to the veterans and the public.

But the committee recognizes that in November 1996, DoD announced it was expanding its investigation and research related to low-level chemical warfare agent exposure. We hope these initiatives can begin to restore confidence in DoD's investigation on chemical agent incidents.

But moving beyond the specific, albeit important, topic, it is important to reiterate that many veterans clearly are experiencing health difficulties connected to their service in the gulf.

First and foremost, it is vital that the government continue to provide the excellent clinical care for these veterans. Next, we must try to find why they are sick. Based on

tions in all these areas.

In closing, I would like to reemphasize that in many important and, in some places, unprecedented ways, the nation has begun to pay its debt to the 697,000 men and

women who served in Operation Desert Shield-Desert Storm. We were impressed with the research the government had already initiated to understand the nature and causes of the illnesses so many veterans suffer from. The committee hopes the same degree of commitment will be applied to the issues still outstanding.

inally, the committee gratefully acknowledges the sig

side government devoted to our effort. We also have been fortunate to have a talented and dedicated staff. On their behalf and on behalf of my fellow committee members, I thank you for your leadership in addressing Gulf War veterans' health concerns and for providing us with the unique

opportunity to contribute to this vitally important issue. President Clinton. Thank you very much to Dr. Lashof and the members of the Presidential Advisory Committee on Gulf War Illnesses: Secretary White, Secretary Brown, Secretary Shalala, Deputy Director Tenet. I'd like to say a special word of thanks to Dr. Jack Gibbons [assistant to the president for science and director of the Office of Science and Technology Policy] for the work that he did on this. I thank Sen. [John D.] Rockefeller [IV], Sen. [Arlen] Specter, Congressman Lane Evans for their interest and their pursuit of this issue, and all the representatives from the military and veterans organizations who are here.

am pleased to accept this report. I thank Dr. Lashof and the committee for their extremely thorough and dedicated work for 18 months now. I pledge to you and to all the veterans of this country, we will now match your forts with our action.

Six years ago, hundreds of thousands of Americans defended our vital interest in the Persian Gulf. They faced a dangerous enemy, harsh conditions, lengthy isolation from their families. And they went to victory for our country with lightening speed. When they came home, for reasons that we still don't fully understand, thousands of them became ill. They served their coun

ef

selves, to form a presidential advisory committee unnat could provide an open and thorough and independent review of the government's response to veterans' health concerns and the causes of their ailments.

Since that time, we have made some real progress. The Department of Defense with the CIA launched a review of more than 5 million pages of Gulf War documents, declassifying some 23,000 pages of materials and putting them on the Internet. Through this effort, we discovered important information concerning the possible exposure of our troops to chemical agents in the wake of our destruction of an arms depot in southern Iraq.

The committee made clear, and the Defense Department agrees, that this new information demands a new approach, focusing on what happened not only during, but after, the war and what it could mean for our troops. Based on the committee's guidance, the Department of Defense has restructured and intensified its efforts, increasing tenfold its

and they must now know that they can rely upon us. And we must not, and will not, let them down.

Three years ago, I asked the secretaries of defense, health and human services and veterans affairs to form the Persian Gulf Veterans Coordinating Board to strengthen our efforts to care for our veterans and find the causes of their illnesses. I signed landmark legislation that pays disability benefits to Gulf War veterans with undiagnosed illnesses. DoD and VA established toll-free lines and medical evaluation programs.

I am especially grateful to the first lady, who took this matter to heart and first brought it to my attention quite a

long while ago now. I thank her for reaching out to the veterans and for making sure that their voices would be heard.

To date, we have provided Gulf War veterans with more than 80,000 free medical exams. We've approved more than 26,000 disability claims. HHS, DoD and the Veterans Department have sponsored more than 70 research projects to identify the possible causes of the illnesses. But early on, it became clear that answers were not emerging fast enough. Hillary and I shared the frustration and concerns of many veterans and their families. We realized the issues were so complex they demanded a more comprehensive effort. That

investigating teams, tracking down and talking to veterans who may have been exposed to chemical agents and devoting millions of dollars to research on the possible effects of low-level chemical expo

sure.

I'm determined that this investigation will be comprehensive and credible. We haven't ended the suffering; we don't have all the answers; and I won't be satisfied until we have done everything humanly possible to find them.

That's why I welcome this committee's report and its suggestions on how to make our commitment even stronger. I also take seriously the concern regarding DoD's investigation of possible chemical exposure. I'm determined to act swiftly on these findings not only to help the veterans who are sick, but to apply the lessons of this experience to the future.

I've asked the secretaries of defense, health and human service, and veterans affairs to report to me in 60 days with concrete, specific action plans for implementing these recommendations. And I am directing Secretary [of Defense]-designate [William S.] Cohen, when confirmed by the Senate [confirmed, Jan.22], to make this a top priority of the Defense Department.

I'm also announcing two other immediate initiatives First, I've asked this committee to stay in business for nine more months to provide independent, expert oversight of DoD's efforts to investigate chemical exposure and also to monitor the governmentwide response to the broader recommendations.

The committee's persistent public effort has helped to

doctors and scientists, as well as Gulf War veterans them

structed them to fulfill their oversight role with the same intensity, resolve and vigor they have brought to their work so far. Dr. Lashof has agreed to continue, and I trust the other committee members will as well.

Second, I'm accepting Secretary Brown's proposal to reconsider the regulation that Gulf War veterans with undiagnosed illnesses must prove their disabilities emerged within two years of their return in order to be eligible for benefits. Experience has shown that many disabled veterans have their claims denied because they fall outside the two-year time frame. I've asked Secretary Brown to report back to me in 60 days with a view toward extending that limit.

nd we will do whatever we can and whatever it takes to research Gulf War illnesses as thoroughly as possible. Every credible possibility must be fully explored, including low-level chemical exposure and combat stress.

I know that Congress shares our deep concern, and let me again thank Sen. Specter, Sen. Rockefeller and Congressman Evans for being here. Caring for our veterans is not a partisan issue, it is a national obligation, and I thank them for the approach that they have taken.

As we continue to investigate Gulf War illnesses, let me again take this opportunity to urge the Congress to ratify the Chemical Weapons Convention, which would make it harder for rogue states to acquire chemical weapons in the future and protect the soldiers of the United States and our allies in the future.

This report is not the end of the road anymore than it is the beginning. We have a lot of hard work that's been done and we have made some progress, but the task is far from over. The committee's assessment gives me confidence that we are on the right track, but we have much yet to learn and much to do.

has been apparent for some time. That's why the Congress agreed to support our efforts that for the first time paid disability payments for people with undiagnosed conditions.

I think that this committee has done a good job. I think - I want to compliment the work that has been done in the last few months by John White of the Defense Department in facing up to the things which were not done before. No one has ever suggested that anybody intentionally imposed exposed American soldiers to these dangers, and there is nothing there is no reason that anyone in this government should ever do anything but just try to get to the truth and get it out and do what is right for the veterans.

And there are also - I think we need to be a little humble about this. There are a lot of things that we still don't know. That's what Dr. Lashof said. And that's why these research projects are so very important.

causes

As we do make progress, we will make our findings public. We will be open in how we view Gulf War illnesses and all their possible causes open to the veterans whose care is in our hands; open to the public looking to us for answers. I pledge to our veterans and to every American, we will not stop until we have done all we can to care for our Gulf War veterans to find out why they are sick and to help to make them healthy again.

Thank you very much.

Q. Mr. President, this has been studied to death. Do you believe that there is a Gulf War illness?

A. I believe that there are a lot of veterans who got sick as a result of their service in the gulf. And I believe it took experts to determine whether there is one or a deliberation of them in exactly what the cause and connection is. That

And the final thing I'd like to say is we don't know all the answers here. You heard Dr. Lashof say that sometimes when people were exposed to substances that can cause cancer it may not be manifested for 10 years, which is why I want to thank Secretary Brown for urging that we stress the two-year rule. We have to — we have to be vigilant about this. And my successor will be working on it. We will be monitoring this for a long time to come.

But we've got a process now the American people and the veterans and their families can have confidence in. We've got the appropriate commitment of personnel and money. And more important, we've got the appropriate commitment of the heart and mind. And I'm convinced now that we will do justice to this issue and to the people that have been affected by it.

Thank you, Mr. President.

Press Conference

Q. Dr. Lashof, just a few minutes ago, Sen. Specter said that they are going to be holding hearings on Thursday on the Hill, and he was talking about the possibility of a cover-up by the Pentagon. Do you agree with that assessment? Do you think that that's... ?

A. We found no evidence of a cover-up in our work. Q. Could we use another word? I mean, was the information adequately conveyed to the public about what they had found?

A. Let me put it this way: They were very slow, and the actual investigation for the possibility of exposure was, we say in the report, superficial and inadequate initially. I think

now.

Q. Was it intentional or ... ?

A. We have no way of judging what their intentions were. We were critical of the lack of effort, and they now have made a commitment. But they can answer that, and I would turn that question to Paul Busick.

Q. Dr. Lashof, in the context of the Defense Science Board investigation of '94, which was presented as a thorough, exhaustive study of exposures, how do you rate that study compared to what you've found out?

A. Well, we obviously uncovered, and it was brought to light, the incident at Khamisiyah [Iraq] that apparently was not known at that time.

Q. Adm. Busick, would you be able to answer the first question?

A. Sure. I think that the Defense Department has acknowledged that it needs to do more and has moved very quickly recently to do more. I think that the secretary of defense has taken the allegations of a cover-up very seriously, and the deputy secretary of defense has instructed the secretary of the Army to launch an Army inspector general investigation into the incident at Khamisiyah. Q. Admiral, why was the department so slow, though?

A. When we get the inspector general's investigation, then we will have more information about what to do, and we look forward to having that.

Q. Why was the initial investigation so slow? You obviously had had the experience of Agent Orange in Vietnam. There was a precedent for this. Why wasn't there a better effort made initially?

A. I think that the PAC report has stated that the Defense Department had two triggering events that they viewed as critical. One was whether the Iraqis presented or used offensive chemical weapons, and the second was whether there were acute symptoms. Q. And what did they find?

A. Neither of those have been found to be the case, and that's in large part why there was no belief that there was a chemical event.

now of long-term health effects from high-level exposures from times when people are ill. The research on long-term effects from low-level is not really available at this point.

In my view, it would be unlikely to see results from low level when we don't see long-term effects from high-level exposure. But we believe that research needs to be done around this, and there are, and we suggest in the committee report, that there are two populations that could be looked at. One is the Japanese in the subway who were exposed, and the other are the pesticide applicators who often are exposed for long times to very low levels. And we think these could be investigated and that question put to

rest.

Q. Just to follow up that, if I might, given the uncertainty about whether any more than one chemical alarm went off at Khamisiyah, do you regard the exposure at Khamisiyah as a case of potential exposure or actual exposure?

A. I think we feel that we know that there were weapons that contained chemical agents at Khamisiyah that were exploded. Therefore, we have to assume that there was exposure to the troops from that release from those weapons that were destroyed at Khamisiyah.

Q. Even if chemical alarms didn't go off?

A. I was going to say, I thought there was a chemical alarm that went

Q. Dr. Lashof, did your inquiry find any evidence of widespread exposure of American troops to chemical weapons, one? And two, do you have any chemical evidence to suggest that low-level exposure causes any of the symptoms that Gulf War veterans are now reporting?

A. The only evidence of exposure that we were able to find... was the event at Khamisiyah. There are reports of other site-specific reading on M-254s and Fox vehicles that need to be further investigated. And that's why we've asked for further investigation of possible exposures. ... There are other reports of detections, but an actual source has only been identified in Khamisiyah.

To your second question of low-level exposure and is this the cause of the illness, we have no clinical evidence

We'll get back - I can get this. They have to research that, and they can get back to you with further detail.

Q. You've termed so far today the Pentagon's response to this problem as being inadequate, superficial, incredible, intransigent, various other adjectives. Yet your conclusion is that they will be able to do the follow-up with a tenfold investigative staff. Isn't there a dichotomy there?

A. I do not believe there is a dichotomy. In fact, I'm glad you asked the question about that. We feel it's very essential that the follow-up be

done and that it be done under very strong oversight with a public view of it. The committee's work, actually, on this issue I think has been misrepresented. I have held back from reporting on the mischaracterizations until our work was finally completed, but let me point out that I think it's unfortunate that our deliberations have been cast in the light that suggests that we have backed off from any suggestion of an independent investigation.

At the committee's September meeting, the staff briefed us on its investigations on the exposure half of the chemical and biological weapons issue. In the transcript of that meeting, the staff reported and I will quote from that transcript because I'd like this to be on the record correctly because it has been misrepresented: "The Depart